Elbow Pain (cont.)

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

What injuries can cause elbow pain, and what are symptoms and signs of the causes of elbow pain?

Lateral epicondylitis (tennis elbow): The lateral epicondyle is the outside bony portion of the elbow where large tendons attach to the elbow from the muscles of the forearm. These tendons can be injured, especially with repetitive motions of the forearm, such as using a manual screwdriver, washing windows, or hitting a backhand in tennis play. Tennis elbow then leads to inflammation of the tendons, causing pain over the outside of the elbow, occasionally with warmth and swelling but always with local tenderness. The elbow maintains its full range of motion, as the inner joint is not affected, and the pain can be particularly noticed toward the end of the day. Repeated twisting motions or activities that strain the tendon typically elicit increased pain. These include lifting and throwing. X-rays are usually normal, but if chronic tendinitis has occurred,
X-rays can reveal calcium deposits in the tendon or reveal other unforeseen abnormalities of the elbow joint.

The treatment of lateral epicondylitis may include ice packs, resting the involved elbow, and anti-inflammatory medications. Anti-inflammatory medications typically used include aspirin and other nonsteroidal anti-inflammatory
drugs
(NSAIDs) such as naproxen (Naprosyn),
diclofenac
(Voltaren), and ibuprofen (Motrin). Bracing the elbow can help. Simple braces for tennis elbow can be found in community pharmacies and athletic goods stores.
Local
cortisone injections are given for persistent pain. Activity
involving the
elbow is resumed gradually. Ice application after activity can
reduce or
prevent recurrent inflammation. Occasionally, supportive straps
can
prevent reinjury. In severe cases, an orthopedic surgical
repair is
performed.

Medial epicondylitis (golfer's elbow): Medial epicondylitis is inflammation at the point where the
tendons of
the forearm attach to the bony prominence of the inner elbow.
As an
example, this tendon can become strained in a golf swing, but
many other
repetitive motions can injure the tendon. Golfer's elbow is
characterized
by local pain and tenderness over the inner elbow. The range of
motion of
the elbow is preserved because the inner joint of the elbow is
not
affected. Those activities which require twisting or straining
the forearm
tendon can elicit pain and worsen the condition. X-rays for
epicondylitis
are usually normal but can indicate calcifications of the
tendons if the
tendinitis has persisted for extended periods of time.

The usual treatment involves combinations of ice packs, resting
the elbow, and medications including aspirin and other NSAIDs.
With severe inflammation, local corticosteroid (cortisone)
injections are
sometimes given. Using a strap can prevent reinjury. After a
gradual
rehabilitation exercise program, return to usual activity is
best
accompanied by ice applications after use. This helps to avoid
recurrent
inflammation.

Olecranon bursitis

Olecranon bursitis (inflammation of the bursa at the tip of the elbow) can occur from injury or minor trauma as a result of
systemic diseases such as gout or rheumatoid arthritis, or
it can
be due to a
local infection. Olecranon bursitis is typically associated with swelling over
the tip of
the elbow, while range of motion of the inner elbow joint is
maintained.

Fractures

The bones of the elbow can break (fracture) into the elbow joint or adjacent to the elbow joint. Typically, elbow fracture causes sharp pain in the elbow, and
X-ray imaging is used to make a diagnosis. Fractures generally require immobilization and casts and can require orthopedic surgery, involving pinning or open joint procedures.

Sprain

A sprain is a stretch or tear injury to a ligament. One or more ligaments can be injured during a sprain. This might occur when the elbow is hyperextended or simply jammed, such as in a "stiffarm" collision. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved. Treatment involves rest, ice, immobilization, compression, and anti-inflammation medications.